Remote capable cardiac treatment method and apparatus

ABSTRACT

A cardiac treatment apparatus, comprising an external cardiac waveform monitor capable of sensing a physiological signal from a heart of a patient and capable of determining if the patient&#39;s heart requires a therapeutic dose of electrical stimulation, an electrical stimulator adapted to deliver the therapeutic dose of electrical stimulation to the heart of the patient and, a wireless transmitter, the wireless transmitter capable of wirelessly transmitting the patient&#39;s sensed physiological data to a remote medical provider.

CROSS-REFERENCE TO RELATED APPLICATIONS

The present application is a divisional application of U.S. Utilitypatent application Ser. No. 14/294,143, filed Jun. 2, 2014.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH

Not Applicable.

TECHNICAL FIELD OF THE INVENTION

The present disclosure relates generally to systems, methods andapparatus for remote, also known as out-of-hospital or pre-hospitaladmission, and remote capable cardiac diagnosis and treatment. Moreparticularly, the disclosure relates to remotely diagnosing and treatingout-of-hospital life threatening arrhtymias such as ventriculartachycardia/fibrillation or severe bradyarrhytmias that may result insyncopal episode or cardiac arrest.

BACKGROUND

Life threatening arrhytmias such as Ventricular Tachycardia orFibrillation and/or severe bradyarrhytmias are the main ethiology ofout-of-hospital cardia arrest. The number one mortality ethiology inwestern world is cardiac disease. In particular, Myocardial infarctionwhich is the medical term for a “heart attack,” is a type of cardiacarrest. When a heart attack occurs, with a subsequent life threateningarrhytmias that alter the pumping action of the heart, the heart isdisrupted such that it does not pump sufficient blood. Broadly speaking,the heart may either stop pumping or it may pump irregularly. In eithersituation, a trained medical professional can use a one-lead rhythmstrip electrocardiograph to evaluate a patient's heart.

At its most basic, electrocardiography is a graphical interpretation ofelectrical activity of the heart over a period of time, as detected byelectrodes attached to the surface of the skin and collected by a deviceexternal to the patient's body. An electrocardiogram (ECG or EKG are twoabbreviations of the term “electrocardiogram) measures the electricalimpulses generated by the polarization and de-polarization of cardiactissue of the heart. The EKG translates these electrical impulses into awaveform. The waveform is used to determine the rate and regularity ofthe subject's heartbeats. Although to establish a diagnoses of a heartattack a 12-lead ECG is currently required, one lead is generallysufficient to detect significant arrhytmias that may require a treatmentwith a defibrillator or a pacemaker in an emergent setting. For example,the characteristic waveform of one beat of a normal heart is illustratedat FIG. 1A. FIG. 1B illustrates an EKG of a normal heart. FIG. 1Billustrates a cardiac cycle representing a P wave, a QRS complex, a Twave and a baseline b that follows until another P wave appears. FIG. 2Aillustrates a characteristic waveform of a severe bradyarrhytmia sb thatrequires stimulation, also known as pacing, by a pacemaker to regulatethe heartbeat. FIG. 2B illustrates a characteristic waveform of a severetachycardia st. FIG. 3A, illustrating ventriular flutter vf, and 3B,illustrating ventricular fibrilation vf′, illustrate characteristicwaveforms of a patient that has suffered a heart attack where theelectrical activity of the patient's heart is irregular and potentiallychaotic. In this situation, the patient's heart is beating, but thechambers are firing chaotically and insufficient blood is being pumpedby the patient's heart. In this situation, a defibrillator is used todepolarize the heart muscle and terminate the dysrhythmia and allow thepatient's body to reestablish a normal sinus rhythm.

At the present time, EKG data can be monitored and transmitted from thepatient to a doctor's office or a health service center. For example,U.S. Pat. No. 8,509,882 discloses a personal monitoring device with asensor assembly configured to sense physiological signals upon contactwith the patient's skin. The sensor assembly produces electrical signalsrepresenting the sensed physiological signals. A converter assembly,integrated with and electrically contented to the sensor assembly,converts the electrical signals generated by the sensor assembly to afrequency modulated physiological audio signal having a carrierfrequency in the range of from about 6 kHz to about 20 kHz.

Additional examples of patient monitoring are disclosed in U.S. Pat. No.5,735,285 which discloses use of a hand-held device that converts apatient's EKG, also referred to as an ECG, into a frequency modulatedaudio signal that may then be analyzed by audio inputting via atelephone system to a selected hand-held computer device or to adesignated doctor's office.

U.S. Patent Application Publication No. 2010/0113950 discloses anelectronic device having a heart sensor including several leads fordetecting a user's cardiac signals. The leads are coupled to interiorsurfaces of the electronic device housing to hide the sensor from view.Using detected signals, the electronic device can then identify andauthenticate the user.

While all of the above are useful in diagnosing conditions of thepatient's heart, they do not address the problem of treatment beforehospital admission. Diagnosis can also be particularly problematicbecause the patient may be unstable or unconsious. It is known thatearly defibrillation/pacing and CPR is critical in out-of-hospitalcardiac arrest. Typically, earlier treatment results in significantlyhigher long-term rates of survival and less acute damage to thepatient's heart, and potentially, the patient's brain. Thus, it would bedesirable to permit an emergent bystander to diagnose and providetreatment with the option of a medical professional to oversight thepatient's management remotely. The present disclosure permits abystander to diagnose and treat onsite and a medical professional toboth remotely diagnose and remotely treat the patient. Phraseddifferently, an emergent bystander without a medical degree or trainingas a first-responder, also referred to as paramedic, could employ thepresently disclosed device to diagnose and treat the patient with theoption of a medical professional to oversight the patient's managementremotely. It is believed that this presently disclosed device will beparticularly useful for a family member to diagnose and treat the familymember's cardiac situation when the family member is remote from ahospital or doctor's office.

SUMMARY OF THE INVENTION

A out-of-hospital cardiac treatment apparatus, comprising; a cardiacwaveform monitor capable of sensing a physiological signal from a heartof a patient and wirelessly transmitting the sensed physiological signalto a remote medical provider; an electrical stimulator adapted todeliver a therapeutic dose of electrical energy to the heart of thepatient; a medical provider transceiver adapted to receive the sensedphysiological signal from the cardiac waveform monitor and alsowirelessly transmit a command signal to control the electricalstimulator.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1A is graphical view illustrating a characteristic waveform of anEKG of an example of one beat of a typical normal heart.

FIG. 1B is a graphical view illustrating an EKG of the rhythm of thenormal heart.

FIG. 2A is a graphical view illustrating a characteristic waveform of anEKG of an example of a severe bradyarrhytmia that requires stimulation,also known as pacing, by a pacemaker to regulate the heartbeat.

FIG. 2B is a graphical view illustrating a characteristic waveform of asevere tachycardia that requires stimulation, also known as pacing, by apacemaker to regulate the heartbeat.

FIG. 3A is a graphical view illustrating a characteristic waveform of anEKG of a patient that has suffered a heart attack where the electricalactivity of the patient's heart is irregular and potentially chaotic andgenerally referred to as ventricular flutter.

FIG. 3B is a graphical view illustrating a characteristic waveform of anEKG of a patient that has suffered a heart attack where the electricalactivity of the patient's heart is irregular and potentially chaotic andgenerally referred to as ventricular fibrilation.

FIG. 4A is a schematic view illustrating a remote cardiac treatmentapparatus.

FIG. 4B is a front plan view illustrating a cardiac waveform monitor.

FIG. 4C is a back plan view illustrating the cardiac waveform monitor ofFIG. 4B.

FIG. 5 is a schematic view illustrating typical positions for electricalstimulator pads on the patient's chest being treated for lifethreatening arrhtymias, such as ventricular tachycardia/fibrillation orsevere bradyarrhytmias.

FIG. 6 is a schematic view illustrating a medical provider transceiver.

FIG. 7A is a schematic view of an alternative embodiment of a remotecardiac treatment apparatus illustrating use of a 12-lead EKG used inconjunction with a cardiac waveform monitor.

FIG. 7B illustrates a the twelve waveforms (I, II, III, AVR, AVL, AVF,V₁, V₂, V₃, V₄, V₅, V₆) of a 12-lead EKG.

FIG. 8 is a block diagram of a method for an emergent bystander todiagnose and treat a heart attack.

FIG. 9 is a block diagram of a method of remotely diagnosing andtreating a heart attack.

DETAILED DESCRIPTION OF THE INVENTION

Certain terms are used throughout the following description and claimsto refer to particular components and configurations. As one skilled inthe art will appreciate, the same component may be referred to bydifferent names. This application does not intend to distinguish betweencomponents that differ in name, but not in function. In the followingdiscussion, and in the claims, the terms “including” and “comprising”are used in an open-ended fashion, and thus should be interpreted tomean “including, but not limited to . . . . ” Also, the term “couple” or“couples” is intended to mean either an indirect or direct electricalconnection. Thus, if a first device couples to a second device, thatconnection may be through a direct electrical connection, or through anindirect electrical connection via other devices and connections.

The foregoing description of the figures is provided for the convenienceof the reader. It should be understood, however, that the embodimentsare not limited to the precise arrangements and figurations illustratedin the figures. Also, figures are not necessarily drawn to scale, andcertain figures may be shown exaggerated in scale or in a generalized orschematic form, in the interest of clarity or conciseness. The same orsimilar elements may be marked with the same or similar referencenumerals.

While various embodiments are described herein, it should be appreciatedthat the present disclosure encompasses many inventive concepts that maybe embodied in a wide variety of contexts. The following detaileddescription of exemplary embodiments, read in conjunction with theaccompanying drawings, is merely illustrative and is not to be taken aslimiting the scope of the invention, as it would be impracticable toinclude all of the possible embodiments of the invention in thisapplication. Upon reading this application, many alternative embodimentsof the present disclosure will be apparent to a person of ordinary skillin the art. The scope of the invention is defined by the appended claimsand equivalents thereof.

Illustrative embodiments of the disclosure are described below. In theinterest of clarity, not all features of an actual implementation aredescribed in this application. In the development of any such actualembodiment, numerous implement-specific decisions may need to be made toachieve design-specific goals, which may vary from one implementation toanother. It will be appreciated that such a development, while possiblycomplex and time-consuming, would nevertheless be a routine undertakingfor a person of ordinary skill in the art having the benefit of thisapplication.

It is considered atypical when a heart attack occurs when a medicalprofessional is present and can render treatment immediately. Asdiscussed above, the short time after the heart attack occurs isreferred to as the “golden” hour. This is not to say that treatmentrendered more than an hour after the patient's heart attack is notvaluable, only that the sooner treatment occurs, the more likely damageto the patient's heart, and potentially the brain, will be minimized, orpotentially, avoided. Thus, it would be valuable to allow a medicalprofessional to both remotely monitor, oversite and remotely treat thepatient suffering from the heart attack or to allow an emergentbystander to monitor and treat the patient suffering from the heartattack.

FIGS. 4A, 4B and 4C illustrate a remote cardiac treatment apparatus 100.A cardiac waveform monitor 20 is seen positioned on an arm of a patientP. Alternatively, the cardiac waveform monitor 20 can be positioned suchthat it contacts the patient's fingertips or chest. Because the cardiacwaveform monitor 20 measures electrical impulses of the patient's heart,it should be positioned so that it can receive these electrical signals.Generally speaking, cardiac waveform monitor 20 performs best when it ispositioned on the patient P's chest or fingertips. FIG. 4B illustrates afront plan view of the cardiac waveform monitor 20. Monitor 20 includesa screen 22 and case 24. FIG. 4C is a back plan view and illustratesattachment plate 26. Attachment plate 26 includes electrodes 28.Collectively, cardiac waveform monitor 20 may be thought of as asingle-channel electrocardiogram. Preferably, screen 22 should displaythe electrocardiogram of the patient P and the patient's pulse rate. Thepreferred embodiment of the cardiac waveform monitor 20 is the AliveCorHeart Monitor sold by AliveCor, Inc., 30 Maiden Lane, 6^(th) Floor, SanFrancisco, Calif. 94108. According to AliveCor's website,www.alivecor.com, the AliveCor Heart Monitor is protected by “U.S. Pat.Nos. 8,301,232, 8,509,882 and [other] patents pending.” U.S. Pat. Nos.8,301,232 and 8,509,882 are incorporated by reference into thisapplication as if set forth fully herein.

In addition, cardiac waveform monitor 20, illustrated in FIGS. 4A, 4Band 4C, may also be adapted to monitor respiration, heart beat, heartrate, electrocardiogram (EKG or ECG), electromyogram (EMG),electrooculogram (EOG), pulse oximetry, photoplethysmogram (PPG) andelectroencephalogram (EEG). An EKG or ECG are measurements of the smallelectrical changes on the skin generated when the heart muscledepolarizes during each heartbeat. The output from a pair of electrodes28 is sent to a patient transceiver 29. Small rises and falls in thevoltage between two electrodes placed on either side of the heart can beprocessed to produce a graphical EKG representation on screen 22 therebyallowing the patient, emergent bystander and medical provider to viewthe EKG.

Nonlimiting examples of suitable cardiac waveform monitors 20 include,but are not limited to, miniature speakers, piezoelectric buzzers, andthe like. The electrical impulses can be received by, for example, amicrophone in a computing device such as a smartphone, personal digitalassistant (PDA), tablet personal computer, pocket personal computer,notebook computer, desktop computer, server computer, and the like. Inits preferred embodiment, cardiac waveform monitor is a smartphone witha touch screen, web browsing, Wi-fi and computing capability able todownload and run mobile applications such as an “app” to monitor andwirelessly transmit cardiac data. A non-limiting example of an “app” or“application software” which can monitor cardiac function and wirelesslytransmit cardiac data is Alivecor's “AliveECG app” for both the Apple'siPhone and Google's Android device.

FIG. 5 is schematic view illustrating typical positions for theelectrical stimulator's pads on the patient P's chest being treated fora heart attack. An electrical stimulator 40 includes pads 42. Pads 42are placed on the chest of the patient P such that they can deliver atherapeutic dose of electrical energy to the heart of the patient P. Asdiscussed above, this stimulation may take the form of electrical energyto pace or depolarize the patent P's heart. Energy source 44 providesthe energy to treat patient P. Alternatively, energy source 44 could besupplemented by an external battery 44′. Because a cardiac waveformmonitor 20 that is a smartphone with a fully charged Li—Po battery has5.92 W hours of energy (21,312 Joules) it will likely provide theapproximately 360 joules of energy required to defibrilate the patient.As such, an external battery 44′ may not be needed. Of course, thisassumes that the smartphone is fully charged. In addition, the abilityof a battery to rapidly discharge is desirable. For example, aLithium-Iron Phosphate Battery (LiFePO₄) discharges very rapidly. Duringdefibrillation, the ability of the energy source to rapidly dischargeand shock the patient's heart is desirable. In the situation where thecardiac waveform monitor 20 is “pacing” the patient's heart, the energysource should be able to provide a voltage of about 2.8 Volt(V).

FIG. 6 illustrates a medical provider transceiver 60. The medicalprovider transceiver 60 includes provider transceiver 62, screen 64 andcase 66. FIG. 6 illustrates that patient transceiver 29 has wirelesslycommunicated waveform N to provider transceiver 60 and waveform N isdisplayed on screen 64. Phrased differently, the waveform signalwirelessly communicated from transceiver 20 should be displayed onscreen 64 of medical provider transceiver 60. In addition to beingviewed on screen 64, the sensed physiological data can be stored on, oneor more computing devices 80. Computing device 80 also permits a user toretrieve the stored sensed physiological data. In a preferredembodiment, a set of instructions, when executed by the one or morecomputing devices 80, can further cause the one or more computingdevices 80 to calculate and display in real-time, a heart rate. Inaddition, demodulated digital EKG data can be processed to identify theoccurrence of an arrhythmia. In such designs, the computing device 80can include instructions to cause the computing device 80 to display awarning on a display screen 64 or emit an audible alert through aspeaker upon detection of a suspected life threatening arrhythmia.Notwithstanding the forgoing, it should be understood that the patienttransceiver 20 can transmit other waveforms and is not limited totransmitting only waveform N. The patient's sensed physiological datacan be wirelessly networked via 3G or Wifi or transmitted via a networkusing USB LAN or any other means or wireless communication system.

Once received by medical provider transceiver 60, patient P's medicaldata can also be emailed or otherwise transmitted to the medicalprovider or viewed in real-time by the medical provider. Medicalinformation such heart beat, heart rate, one lead rhythm stripelectrocardiogram (EKG or ECG), can be provided to the medical providerthrough a smart phone or other computing device. Alternatively, theinformation could be stored on a computing device or serve and accessedby the medical provider.

FIG. 7A illustrates a schematic view of an alternative embodiment of aremote cardiac treatment apparatus 200. The remote cardiac treatmentapparatus 200 is illustrating as used in conjuction with a 12-lead EKG250. It is known that a single lead EKG, such as the used in conjunctionwith a cardiac waveform monitor 220, is generally considered inadequateto diagnose ventricular flutter or ventricular fibrillation,illustrative examples of which are illustrated in FIGS. 3A and 3B. Thus,a user may elect to use 12-lead EKG 250, as opposed to single-lead EKG,for a more complete determination of the cardiac situation of patient P.Screen 222, of the cardiac waveform monitor 220, displays the 12waveforms generated by a 12-lead EKG 250. Cardiac waveform monitor 220is illustrated as having case 224 and transceiver 229. Cardiac waveformmonitor 220 may also be positioned on the patient P's chest orfingertips.

FIG. 7B illustrates a 12-lead EKG 250 which displays 12 (twelve)waveforms (I, II, III, AVR, AVL, AVF, V₁, V₂, V₃, V₄, V₅, V₆), ratherthan the single wave form displayed by monitor 20 on screen 22. Itshould also be noted that leads are attached to the patient P at thelocations illustrated in FIG. 7A. These are generally accepted positionsfor leads for 12-lead EKG 250 and, preferably, should not be varied. Itis within the scope of the present invention that the number of EKGleads could vary.

FIG. 8 illustrates a method for an emergent bystander to diagnose andtreat a heart attack when a patient is remote, out of hospital, from amedical provider 300. At 310, the emergent bystander externallypositions a cardiac waveform to monitor a patient, the cardiac waveformmonitor capable of sensing a physiological signal from a heart of thepatient. At 320, the cardiac waveform monitor senses the physiologicalsignal of the patient's heart. At 330, the cardiac waveform monitordetermines if the patient's heart requires electrical stimulation. Itshould be understood that not all of the heart's conditions can beeffectively treated by electrical stimulation. Thus, the electricalstimulation will not be delivered if the patient's heart rhythms are notshockable or paceable. At 340, if the patient's heart does not requireelectrical stimulation, the physiological signal from the heart of thepatient is wirelessly transmitted to a remote medical provider. If thepatient's heart requires electrical stimulation, an electricalstimulator is positioned externally proximate the patient's heart at350. It should be understood that the electrical stimulator could bepositioned before a treatment determination is made. However, it isprobably preferable not to position the external electrical stimulatoruntil after a treatment determination has been made to mitigate any riskof an unnecessary electrical stimulation of the patient. At 360, thepatient's heart is electrically stimulated. At 370, a post-electricalstimulation sensed physiological signal from the patient's heart iswirelessly transmitted to a remote medical provider.

FIG. 9 illustrates a method of remotely delivering cardiac treatment400. At 410, the medical provider transceiver receives a sensedphysiological signal from a heart of a patient, the patient is locatedremotely from a medical provider and the medical provider's transceiveris adapted to wirelessly receive the sensed physiological signal. At420, the patient's identify is validated. This could be through anidentifying code transmitted by the patient's transceiver or throughbiometric data. At 430, the medical provider determines an appropriatetherapeutic dose of electrical energy, such as pacing or defibrillation.At 440, it is determined if a medical provider is authorized to transmita command signal to control an electrical stimulator. The medicalprovider's authority to provide electrical stimulation to the patientcan be validated by a biometric reader or entry of a password or thelike. At 450, only if the medical provider's authority to provideelectrical stimulation to the patient has been validated, the medicalprovider can transmit a command signal to control an electricalstimulator to deliver the appropriate therapeutic dose of electricalenergy. It should be understood that not all of the heart's conditionscan be effectively treated by electrical stimulation. Thus, theelectrical stimulation will not be delivered if the patient's heartrhythms are not shockable or paceable. At 460, the medical providerreceives a post-stimulation sensed physiological signal from a heart ofa patient, the patient located remotely from a medical providertransceiver adapted to receive the post-stimulation sensed physiologicalsignal. In this manner, the medical provider can determine if theelectrical stimulation has achieved the desired result of appropriatelyrestoring the patient's heart function.

Additional Information Concerning Electrical Stimulation

Modern defibrillators deliver current based on stored energy. Datademonstrates that 4 pad positions (anterolateral, anteroposterior,anterior-left infrascapular, and anterior-right-infrascapular arepreferred. Ten studies indicated that larger pad/paddle size (8 to 12 cmdiameter) lowers transthoracic impedance and that this is a preferredembodiment. To reduce transthoracic impedance, the defibrillatoroperator should use conductive materials. This is accomplished with theuse of gel pads or electrode paste with paddles or through the use ofself-adhesive pads

Direct current defibrillators store an electrical charge and dischargeit across two paddle electrodes in a damped, sinusoidal waveform. Theshock terminates arrhythmias caused by re-entry by simultaneouslydepolarizing large portions of the atria or ventricles, thereby causingthe re-entry circuits to extinguish.

Cardioversion refers to the termination of SVT or VT by delivery of ashock in synchrony with the QRS complex. When shocks are delivered toterminate VF, synchronization to the QRS complex is not necessary, andthis process is referred to as defibrillation

In the anteroapical configuration, one electrode is positioned to theright of the sternum at the level of the second intercostal space, andthe second electrode is positioned at the midaxillary line, lateral tothe apical impulse. In the anteroposterior configuration, an electrodeis placed to the left of the sternum at the fourth intercostal space,and the second electrode is positioned posteriorly, to the left of thespine, at the same level as the anterior electrode. These two-electrodeconfigurations result in similar success rates of cardioversion anddefibrillation.

Important variables affecting the success of cardioversion ordefibrillation are the shock waveform and shock strength. Defibrillatorsthat deliver biphasic shocks are now clinically available and have asignificantly higher success rate than conventional defibrillators.Other technique-dependent variables that maximize delivery of energy tothe heart include firm paddle pressure, delivery of the shock duringexpiration, and repetitive shocks

Asynchronous shocks may precipitate VF. Rarely, VF may occur even whenshocks are synchronized to the QRS complex.

Biphasic Waveform Defibrillators-Data from both out-of-hospital andin-hospital studies indicate that lower-energy biphasic waveform shockshave equivalent or higher success for termination of VF than either MDSor MTE monophasic waveform shocks. However, the optimal energy forfirst-shock biphasic waveform defibrillation has not been determined.One study in which a pulsed biphasic waveform was used showed afirst-shock success rate of 90%. There is no new evidence regarding thefirst-shock success rate with the rectilinear biphasic waveform sincepublication of the 2005 Guidelines. Several randomized and observationalstudies have shown that defibrillation with biphasic waveforms ofrelatively low energy (≦200 J) is safe and has equivalent or higherefficacy for termination of VF than monophasic waveform shocks ofequivalent or higher energy.

Biphasic waveforms are safe and have equivalent or higher efficacy fortermination of VF when compared with monophasic waveforms. In theabsence of biphasic defibrillators, monophasic defibrillators areacceptable (Class IIb, LOE B)

For biphasic defibrillators, providers should use the manufacturer'srecommended energy dose (eg, initial dose of 120 to 200 J) (Class I, LOEB). Higher energy might be biphasic waveforms of 200 to 400 J, 401-600 Jor even higher.

Human studies have not demonstrated evidence of harm from any biphasicwaveform defibrillation energy up to 360 J, with harm defined aselevated biomarker levels, ECG findings, and reduced ejection fraction.

A pacemaker typically delivers energy in a range from about 15 to 45 Jwhen pacing the patient's heart.

We claim:
 1. A cardiac treatment apparatus, comprising: an externalcardiac waveform monitor capable of sensing a physiological signal froma heart of a patient and capable of determining if the patient's heartrequires a therapeutic dose of electrical stimulation; an electricalstimulator adapted to deliver the therapeutic dose of electricalstimulation to the heart of the patient; a wireless transmitter, thewireless transmitter capable of wirelessly transmitting the patient'ssensed physiological data to a remote medical provider.
 2. The cardiactreatment apparatus of claim 1 wherein the cardiac waveform monitor is asmartphone.
 3. The cardiac treatment apparatus of claim 1, furthercomprising an external battery.
 4. The cardiac treatment apparatus ofclaim 1, wherein the therapeutic dose of electrical stimulation pacesthe patient's heart.
 5. The cardiac treatment apparatus of claim 1,wherein the therapeutic dose of electrical stimulation defibrillates thepatient's heart.
 6. The cardiac treatment apparatus of claim 1, whereinthe therapeutic dose of electrical stimulation either paces ordefibrillates the patient's heart.
 7. The cardiac treatment apparatus ofclaim 6, wherein the electrical stimulator delivers a biphasal waveformshock.
 8. The cardiac treatment apparatus of claim 6, wherein theelectrical stimulator delivers a monophasal waveform shock.
 9. Thecardiac treatment apparatus of claim 6, wherein the electricalstimulator delivers a biphasal waveform shock of less than 200 Joules.10. The cardiac treatment apparatus of claim 1, further comprising: amedical provider transceiver configured to receive the patient's sensedphysiological data.
 11. A cardiac treatment system, comprising: anexternal cardiac waveform monitor capable of sensing a physiologicalsignal from a heart of a patient; an electrical stimulator capable ofdelivering a therapeutic dose of electrical stimulation to the heart ofthe patient; and a patient transceiver capable of wirelesslytransmitting the sensed physiological signal to a location remote fromthe location of the cardiac waveform monitor.
 12. The cardiac treatmentsystem of claim 12, further comprising: a medical provider transceiverconfigured to receive the patient's sensed physiological signal.
 13. Thecardiac treatment system of claim 12, wherein the cardiac waveformmonitor is a smartphone.
 14. The cardiac treatment system of claim 12,further comprising providing an external battery.
 15. The cardiactreatment system of claim 12, wherein the therapeutic dose of electricalstimulation paces the patient's heart.
 16. The cardiac treatment systemof claim 12, wherein the therapeutic dose of electrical stimulationdefibrillates the patient's heart.
 17. The cardiac treatment system ofclaim 12, wherein the therapeutic dose of electrical stimulation eitherpaces or defibrillates the patient's heart.
 18. The cardiac treatmentsystem of claim 17, wherein the electrical stimulation delivers abiphasal waveform shock.
 19. The cardiac treatment system of claim 17,wherein the electrical stimulation delivers a monophasal waveform shock.20. The cardiac treatment system of claim 17, wherein the electricalstimulation delivers a biphasal waveform shock of more than 120 Joulesand less than 200 Joules.
 21. A remote cardiac treatment apparatus,comprising; a cardiac waveform monitor capable of sensing aphysiological signal from a heart of a patient and wirelesslytransmitting the sensed physiological signal to a remote medicalprovider; an electrical stimulator adapted to deliver a therapeutic doseof electrical energy to the heart of the patient; a medical providertransceiver adapted to receive the sensed physiological signal from thecardiac waveform monitor and also wirelessly transmit a command signalto control the electrical stimulator.
 22. The remote cardiac treatmentsystem of claim 22, wherein the cardiac waveform monitor is asmartphone.
 23. The cardiac treatment system of claim 22, furthercomprising an external battery.
 24. The remote cardiac treatment systemof claim 22, wherein the therapeutic dose of electrical energy paces thepatient's heart.
 25. The remote cardiac treatment system of claim 22,wherein the therapeutic dose of electrical energy defibrillates thepatient's heart.
 26. The remote cardiac treatment system of claim 22,wherein the therapeutic dose of electrical energy either paces ordefibrillates the patient's heart.
 27. The remote cardiac treatmentsystem of claim 26, wherein the electrical stimulator delivers abiphasal waveform shock.
 28. The remote cardiac treatment system ofclaim 26, wherein the electrical stimulator delivers a monophasalwaveform shock.
 29. The remote cardiac treatment system of claim 26,wherein the electrical stimulator delivers a biphasal waveform shock ofmore than 120 Joules and less than 200 Joules.
 30. The remote cardiactreatment system of claim 26, wherein the electrical stimulator deliversa biphasal waveform shock of less than 200 Joules.